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A survey of injuries from the West fertilizer plant explosion will be complete in June.

A report on injuries from last year’s fertilizer plant explosion in West will be finished next month, health officials say. A spokeswoman for McLennan County’s public health department said details are still being worked out, but the city of West will get the information first. After a meeting with West officials, the information will be released to the public at large via the health department’s website.

Preliminary figures show about 260 people sought care at hospitals and urgent care clinics after the blast. Health officials in McLennan County and the Texas Department of State Health Services are conducting the survey.

Last month, I wrote this story about what the survey does and doesn’t cover. It focuses on people with immediately apparent physical injuries who went to a hospital or urgent care clinic. But I found that many didn’t go to the hospital and sought care elsewhere.

The survey also doesn’t cover mental health issues common after disasters or follow survivors long-term. Many in West have ongoing health issues.

Public health and policy experts say a thorough survey is needed, now that lawmakers are weighing new safety rules.

An aerial photo taken the day after the West explosion shows the damaged nursing home at lower left and the fertilizer plant at upper right.

The U.S. congressman who represents West has asked Texas’ state health department for a “more comprehensive investigation” of the health effects of last year’s fertilizer plant explosion that killed 15 people.

Rep. Bill Flores, R-Bryan, in a letter his office said was mailed Thursday to the head of Texas’ Department of State Health Services, wrote he was writing as “a concerned citizen.”

“The City of West is now counting on you to provide comprehensive data on the magnitude of injuries that span from mental health issues to physical health problems which can develop over time,” Flores wrote.

The survey focuses only on immediately apparent physical injuries treated at hospitals soon after the blast. It omits people who sought care at private medical practices. It also doesn’t specifically inquire about injuries diagnosed after patients left the hospital, and is not tracking mental health issues.

New managers took control of Cozby-Germany Hospital after Dr. Tariq Mahmood was evicted.

Cozby-Germany Hospital has shut down, we’ve just learned. It’s in Grand Saline, about 65 miles east of Dallas, and government records identify it as the lone hospital in Van Zandt County.

It was controlled until last month by Dr. Tariq Mahmood, who has been charged with conspiring to overbill the government for patient care there and elsewhere in his chain of small-town Texas hospitals. Federal regulators have also documented dire threats to patient safety at most of the facilities.

Cozby-Germany’s landlord evicted Mahmood’s management company “after nearly two years of disputes over unpaid rent and concerns about financial practices and substandard care,” my colleague Miles Moffeit reported in July. New managers closed it last Thursday, citing lack of money. Hospital board members say they hope to reopen it soon, the Grand Saline Sun reports.

Mahmood, who lives the Dallas County suburb of Cedar Hill, lost control of all six of his hospitals this year. Some are open under new management. But the one closest to Dallas, Renaissance Hospital Terrell, remains padlocked.

Mahmood is free on bond on the conspiracy charge and denies any wrongdoing.

Apartments destroyed in the West blast (left) and the federal building destroyed in Oklahoma City in 1995 (right). File photos.

In Sunday’s paper, I wrote a story comparing how Texas health authorities have responded to the blast in West to how Oklahoma health authorities responded to the 1995 bombing there.

Two days after the Oklahoma City bombing, the state of Oklahoma began tracking injuries related to the blast. The state health commissioner invoked a rule requiring doctors and hospitals to report all related injuries, allowing the state to collect vital information on treatment and safety.

The response of Texas’ state health department, the Texas Department of State Health Services, has been very different following the April 17 explosion of the fertilizer plant in West. State authorities have waited for McLennan County’s health officials to agree to a study, even though no law prevents the state from conducting one on its own.

As a result, the decision to even do a study wasn’t made until late June. It’s still in the planning stages and there is no timeline for when it will get underway. A study documenting injuries could show what’s at stake for the 20,000 other Texans who live close to the state’s 73 other facilities that store large amounts of ammonium nitrate, the chemical that exploded in West.

Proposed abortion restrictions have drawn crowds of protesters and supporters to the Capitol in Austin.

Texas legislators resume debate next week on proposed abortion restrictions. Advocates say they want to protect women and unborn children. Opponents say the restrictions would force all but five of the state’s abortion providers to close, infringing on women’s legal rights and endangering their health. Here is some information to consider when weighing the arguments.

What makes HB2 controversial? Three provisions have attracted the most attention:

Abortion clinics would have to begin meeting the infrastructure requirements of facilities that specialize in outpatient surgeries – so-called ambulatory surgical centers. This would mean major new expenses.

Most abortions would be illegal 20 weeks or more after conception. Proponents say fetuses can feel pain by that point; opponents disagree. The current rule is 24 weeks.

Doctors performing abortions would need permission to admit patients at a hospital within 30 miles, in case the pregnant female experiences complications. Some abortion doctors currently lack hospital privileges.

Have similar measures been enacted elsewhere? About half the states have taken some steps like these, sometimes inspiring legal challenges.

How many ambulatory surgical centers perform abortions? Four reported abortions in 2011, the most recent year for which statistics are available. One abortion clinic in Fort Worth recently converted to a surgical center that performs abortions.

Which abortions would Texas permit after 20 weeks? There are two types: those necessary to save the pregnant female’s life or “major bodily function,” and those “performed on unborn children with severe fetal abnormalities.”

In an interview this week with the Tribune, Shannon was quoted as saying he was “proud of some of the accomplishments we made in Parkland” during his 2007-2012 tenure. He went on to say:

“But clearly we had some spectacular medical failures. And no one is proud of that, no one’s happy about that. … I’m very sorry that I didn’t see them across the finish line. They’ll be going through a re-survey, and I’m quite sure they will be successful this time.”

Shannon told the Tribune that he had worked closely with safety monitors installed by the U.S. Centers for Medicare & Medicaid Services after a 2011 inspection found patients were in “immediate jeopardy.” By April, Parkland is scheduled to undergo a re-inspection to test whether patient-care corrections are working.

Parkland did not pay a $750,000 fine when it was due in September. As a result, state officials say, the public hospital may owe more money.

“There is simply no excuse for what happened,” said a statement issued on behalf of Debbie Branson, chair of Parkland’s governing board. “Appropriate changes will result.”

Branson and other Parkland representatives did not respond to a request for elaboration. But records obtained by The Dallas Morning News do recount an explanation that two hospital leaders gave in a Dec. 4 phone call to a Texas Department of State Health Services employee.

“They had it set up in their accounting section to send a wire transfer,” says the summary, but “the person that was responsible for sending it out resigned before it was sent.”

Parkland would not identify the employee or the reason for resignation. Continue reading →

Here's a mock-up of what a maternity patient's room could look like at the new Parkland, which is scheduled to open in 2015.

This post was updated at 3:40 p.m. today, Dec. 4, 2012 and again at 10:10 a.m Dec. 5.

State regulators are hitting Parkland Memorial Hospital again because of patient-safety breakdowns.

Dallas County’s troubled public hospital failed to investigate two sudden, unexpected deaths and a third case in which a patient “was suspected of having blood transfusion complications,” the Texas Department of State Health Services says. Such internal investigations are legally required.

One death involved a cardiac patient on the day of scheduled discharge. The patient was experiencing rapid heartbeat and low blood pressure when injected with metoprolol, a drug often used to treat high blood pressure.

“Less than one minute later, patient became unresponsive” and soon died, says a violation notice that DSHS sent to Parkland last week.

The second cited death involved a pregnant woman who came to the labor and delivery unit “with complaints of leaking amniotic fluid.” The next day, she felt nauseated, had trouble breathing and suffered a seizure. She died as doctors prepared for a possible cesarean section. So did the fetus.

The violation notice doesn’t say what happened to the transfusion patient. All the cases occurred this summer.

Parkland hasn’t responded to a request for comment about this matter. UPDATE #1: Parkland spokeswoman April Foran just issued this comment via email: “Parkland has received three findings of violations that will cost the hospital $650 each. One violation was for a documentation error. The other two were in response to Parkland’s failure to follow its policy regarding investigations of adverse events. Neither issue put any patient at clinical risk.

“These findings resulted from issues Parkland self-reported to the state. Since summer, when these events occurred, Parkland has redesigned its Quality and Patient Safety Department in order to streamline and speed up our reporting of adverse events to the state. On the documentation issue, our nursing department implemented corrective education to ensure all reports are completed correctly in the future. Parkland has been and will continue to cooperating fully with the state on these types of issues.” Continue reading →

A storm knocked out electrical service to the hospital July 15. Then an emergency generator failed. Patients and caregivers were in the dark for nearly two hours.

No patients were affected, the hospital said previously. A spokeswoman hasn’t responded to my interview request today. (See below.)

The Texas Department of State Health Services says it expects to finish its on-site work today and deliver a report to the hospital in about two weeks.

UPDATE: “It’s rare for a backup generator to fail at a hospital,” DSHS spokeswoman Carrie Williams told me. “The potential for a negative patient outcome is there, particularly if patients are in surgery or on ventilators. In this case, we’re not aware of any reports of negative patient outcomes.”

On Sunday, July 15, a thunderstorm disrupted our hospital’s electrical power supply. During the incident, our standby generator also experienced a disruption. Our main priority is the safety of our patients and visitors. Our physicians and staff worked quickly to minimize the inconvenience and ensure that our patients continued to receive safe and proper care. We immediately contacted our electric delivery company, which restored power to our hospital, and we obtained an emergency generator to ensure that an alternative power source was in place.

Even though power had been restored to our hospital that evening, patient and visitor safety is a top priority, and we kept the emergency generator for five days in an abundance of caution. Our back-up generator received immediate attention following the outage and the mechanical malfunction that caused the disruption was immediately repaired.

Today, the Texas Department of Health conducted an inspection on our hospital’s backup generator. The generator preformed properly during our tests and also performed properly during the Department’s inspection.

We take the health and safety of our patients, our employees and our visitors very seriously. We routinely practice for situations like this to ensure that we’re able to respond quickly, appropriately, and in accordance with our emergency management plans.